Cardiology Fellow Rochester Hills, Michigan, United States
Disclosure(s):
Michael M. Kattula, DO: No financial relationships to disclose
Background: Preclinical studies have shown acute improvement in LV function and reduction of ventricular arrhythmias during and after SSO2 coronary infusion. Clinical studies have also shown similarly potential benefits. Accordingly, anterior STEMI patients presenting with cardiogenic shock and/or successful resuscitation post cardiac arrest were treated with coronary SSO2 post successful PCI.
Methods: Here, we report the results of seven such patients treated with SSO2 post successful PCI. Cardiac arrest/CPR had been performed successfully in 5 of the patients, 3 in the ED and 2 Out-of-Hospital. In addition to iv pressor support on presentation, Impella had been placed in 3 patients and IABP in 1 patient for hemodynamic support. Cardiogenic Shock staging was classified utilizing the CSWG Shock Classification Calculator. Ejection Fraction was determined by left ventriculogram prior to initiation of SSO2 therapy, and by serial echocardiograms. All patients had an echocardiogram within 24 hours of the index procedure. Follow up echocardiograms were repeated within approximately 1 week, 30 days, and/or beyond 90 days.
Outcome: No procedural-related or cardiac complications were noted from the index event, ventricular arrhythmias 0%, and clinical systolic heart failure 0% acutely or on follow-up at 3 months. Average baseline ejections fraction prior to SSO2 therapy was 28% by ventriculogram prior to revascularization and 35% by echocardiogram within 24 hours of revascularization. There was an average increase in ejection fraction by 18% within approximately 30 days from the initial echocardiogram performed within 24 hours from the index procedure. When compared to previous published data at our institution, this increase is significantly greater than our control arm of patients who were not in cardiogenic shock and did not receive SSO2 therapy. Accordingly, in patients who did receive SSO2 therapy in our previously published data, we see a similar response in ejection fraction recovery with a trend favoring a greater response in this critically ill cohort of patients.
Conclusion: SSO2 therapy for anterior STEMI patients presenting with cardiogenic shock or cardiac arrest but successfully re-perfused with PCI should be considered for inclusion in future clinical trials.
